Permit CITY OF TIGARD MECHANICAL PERMIT
: COMMUNITY DEVELOPMENT Permit#: MEC2022-01112
T I GAI.n 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/1/2022
Parcel: 2S 104BC08400
Jurisdiction: Tigard
Site address: 12970 SW OXALIS TER
Project: Wakem Subdivision: HILLSHIRE CREST Lot: 6
Project Description: 40'of gas line to outdoor fire pit.
Contractor: PETERSON PLUMBING&MECHANICAL CO Owner: WAKEM, LYNN&GRETCHEN REVOCABLE TRU
59897 ETHAN LANE 12970 SW OXALIS TER
ST HELENS, OR 97051 PORTLAND, OR 97223
PHONE: 503-927-9103 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 12/01/2022 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 12/01/2022 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 12/01/2022 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. hose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
//1
Issued By: :7 „ ,l� Permittee Signature: t
ji
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
DateBy: Iai/ate PermitNo.: ,yt 21.31. _on It�
• 13125 SW Hall Blvd.,Tigard,OR 97223 4.Plan Review l II Phone: 503.718.2439 Fax 503.598.1960 DatBy other Permit:
l 1 L n i.E) Inspection Line: 503.639.4175 Date Ready/By: Dais: Ri See Page 2 for
Internet: www.ti -err. v
� Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
❑New construction (]Addition/alteration/replacement p rfo Mechanical permit thee'are based on to thevalue of the work
performed.Indicate value(rounded to nearest dollar)of all
❑Demolition Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ 5 ':
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
PP I-and 2-family dwelling 0 Commercialindustrial 0 Accessory building For special information use dadaist
❑Multi-family 0 Master builder 0 Other: Description 1 Qty. l Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 11.,9,70 5"✓ OXot 1:6 lev.✓ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Poejk . OR 171,13 Furnace 100,000+BTU(ducts/vents) 54.91
I Heat pump 61.06
Suite/bldg./apt.no.: Project name: WI ka„,, Gove.,J �er k Duet work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
�f Residential boiler(radiator or
dKa1� 1e,nr a Stare (a .e) hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fluel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39 ,
p 1 �" (� Flue vent for water heater or gas
Tie kro eYiSI:sS Service n `tier wteh'r 4- Iuelere fireplace 23.32
katse. Rt,, U -/v' c t 1„ qus fine 4e loglignter(gas) 23.32
II A n�1 U Wood/pelletstove 33.39
or+t lace- };s'B n:� Wood fireplace/insert 23.32
t Chimney/liner/flue/vent 23.32 ,
Other: 23.32
9 PROPERTY OWNER 0 'TENANT Environmental exhaust and ventilation:
Name: yh n 14/4 k e� n. Range hood/other kitchen
equipment 33.39
Address: a ei 70 5 W 0 Xa 1.5 T e r Clothes dryer exhaust 33.39
City/State/ZIP: PGA}1M.e4 O( 1 7a 3 Single-duct exhaust(ballrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawispace fans 23.32
0 APPLICANT 1 CONTACT PERSON Other: 23.32
S1,lt ltw.c CoviS t ctee //LLC. Fuel piping: lsR.tiJ
'
Business name: CJ
r II $14.15 for first for$4.03 for each additional
Contact name: '1 1w,..to 5 C wt.a v.Ir‘ Furnace,etc.
Address: 9410 5- c
5 5 Gas heat pump
lt1 f"a "S` l WalVsuspended/unitheater
City/State/ZIP: Par}LMJ 012 97103 Water heater
Phone:(17( ) 360 LCc . Fax: :( ) Fireplace
!' 11 Range
E-mail: ( ,. S G Si lakeCost kill- ev, PnIX . co..-- Barbecue
V CONTRACTOR�ry /•
Clothes dryer(gas)
Business name: P Fl L. S M to ,..c i C- ., Offer:
e���"'^ """ 'a 1 MECHANICAL PERMIT FEES'
Address: SI it.,17 E+Lc,tw l-n1 q Subtotal
City/State/ZIP: 5l, gla„� O oC 1'7OS, Minimum permit fee($90.00)
Phone:(jo3 ) 1 - 9 p 3 Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.: 1.19 1 7c TOTAL PERMIT FEE .
This permit application expires ifs permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatU * Fee methodology set by Tri-County Building Industry Service Board
Print name:1.ss.„.5 C►„,«,t‘:,t Date: O.- I f)."-
I:\Boldineermita LC_PemritApp 040113.doe 440-4617r(11/02/COM/WEB)